Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2102803 | TX |
NPI | 1013357060 |
---|---|
Provider Name | Bianca St Julian |
First Address | Houston, TX 77011-2108 |
Second Address | Phoenix, AZ 85040-4823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2013 |
Last Update Date | 14/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00000000000 | (05) | TX |